Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ICD DEFIB INT W/PROG MULTIPLE

Facility

$231.20

Service Code	HCPCS 93284
Hospital Charge Code	5300163
Hospital Revenue Code	480
Min. Negotiated Rate	$34.68
Max. Negotiated Rate	$34.68
Rate for Payer: Qualcare PPO/HMO/WC	$34.68

ICD DEFIB INT W/PROG MULTIPLE

Facility

$231.20

Service Code	HCPCS 93284
Hospital Charge Code	5300163
Hospital Revenue Code	480
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.36
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.68
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

ICD DEFIB INT W/PROG MULTIPLE

Facility

$231.20

Service Code	HCPCS 93284
Hospital Charge Code	94053080
Hospital Revenue Code	480
Min. Negotiated Rate	$34.68
Max. Negotiated Rate	$34.68
Rate for Payer: Qualcare PPO/HMO/WC	$34.68

ICD DEFIB INT W/PROG MULTIPLE

Facility

$214.68

Service Code	HCPCS 93284
Hospital Charge Code	74117020
Hospital Revenue Code	480
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$32.20

ICD DEFIB INT W/PROG MULTIPLE

Facility

$214.68

Service Code	HCPCS 93284
Hospital Charge Code	74117020
Hospital Revenue Code	480
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.20
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.69

ICD DEFIB INT W/PROG MULTIPLE

Facility

$214.68

Service Code	HCPCS 93284
Hospital Charge Code	74115020
Hospital Revenue Code	480
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.20
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.69

ICD DEFIB INT W/PROG SINGLE

Facility

$214.68

Service Code	HCPCS 93282
Hospital Charge Code	74117018
Hospital Revenue Code	480
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.20
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.69

ICD DEFIB INT W/PROG SINGLE

Facility

$214.68

Service Code	HCPCS 93282
Hospital Charge Code	74115018
Hospital Revenue Code	480
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.20
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.69

ICD DEFIB INT W/PROG SINGLE

Facility

$231.20

Service Code	HCPCS 93282
Hospital Charge Code	94053070
Hospital Revenue Code	480
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.36
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.68
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

ICD DEFIB INT W/PROG SINGLE

Facility

$214.68

Service Code	HCPCS 93282
Hospital Charge Code	74115018
Hospital Revenue Code	480
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$32.20

ICD DEFIB INT W/PROG SINGLE

Facility

$214.68

Service Code	HCPCS 93282
Hospital Charge Code	74117018
Hospital Revenue Code	480
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$32.20

ICD DEFIB INT W/PROG SINGLE

Facility

$231.20

Service Code	HCPCS 93282
Hospital Charge Code	94053070
Hospital Revenue Code	480
Min. Negotiated Rate	$34.68
Max. Negotiated Rate	$34.68
Rate for Payer: Qualcare PPO/HMO/WC	$34.68

ICD DEFIB INT W/PROG SINGLE

Facility

$231.20

Service Code	HCPCS 93282
Hospital Charge Code	5300161
Hospital Revenue Code	480
Min. Negotiated Rate	$34.68
Max. Negotiated Rate	$34.68
Rate for Payer: Qualcare PPO/HMO/WC	$34.68

ICD DEFIB INT W/PROG SINGLE

Facility

$231.20

Service Code	HCPCS 93282
Hospital Charge Code	5300161
Hospital Revenue Code	480
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.36
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.68
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

ICD DEFIB INT W/PROG SINGLE

Facility

$214.68

Service Code	HCPCS 93282
Hospital Charge Code	74116018
Hospital Revenue Code	480
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$32.20

ICD DEFIB INT W/PROG SINGLE

Facility

$214.68

Service Code	HCPCS 93282
Hospital Charge Code	74116018
Hospital Revenue Code	480
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.20
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.69

ICE PACK INSTANT

Facility

$43.25

Hospital Charge Code	270655045
Hospital Revenue Code	270
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.62
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$12.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.03
Rate for Payer: Cigna Commercial	$21.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.97
Rate for Payer: Oxford Commercial	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$6.49
Rate for Payer: UnitedHealthcare Commercial	$8.65
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

ICE PACK INSTANT

Facility

$43.25

Hospital Charge Code	270655045
Hospital Revenue Code	270
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.49

ICHTHAMMOL OINT 10% 28GM

Facility

$113.30

Hospital Charge Code	6003008
Hospital Revenue Code	252
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

ICHTHAMMOL OINT 10% 28GM

Facility

$113.30

Hospital Charge Code	6003008
Hospital Revenue Code	252
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$56.65
Rate for Payer: Aetna Commercial	$43.05
Rate for Payer: Aetna Medicare Advantage	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.89
Rate for Payer: Cigna Commercial	$56.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.99
Rate for Payer: Oxford Commercial	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$22.66
Rate for Payer: UnitedHealthcare Community & State	$2.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.00

IC MOLDABLE STRIP 50MM FZ

Facility

$4,115.00

Hospital Charge Code	270671274
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$2,057.50
Rate for Payer: Aetna Commercial	$1,563.70
Rate for Payer: Aetna Medicare Advantage	$1,234.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,049.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,049.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$823.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,049.33
Rate for Payer: Cigna Commercial	$2,057.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$995.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$905.30
Rate for Payer: Qualcare PPO/HMO/WC	$617.25
Rate for Payer: UnitedHealthcare Community & State	$99.17
Rate for Payer: Wellpoint Medicaid Managed Care	$109.05

IC MOLDABLE STRIP 50MM FZ

Facility

$4,115.00

Hospital Charge Code	270671274
Hospital Revenue Code	278
Min. Negotiated Rate	$617.25
Max. Negotiated Rate	$995.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$823.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$995.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$905.30
Rate for Payer: Qualcare PPO/HMO/WC	$617.25

IC MOLDABLE STRIP 90MM FZ

Facility

$7,000.00

Hospital Charge Code	270671275
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

IC MOLDABLE STRIP 90MM FZ

Facility

$7,000.00

Hospital Charge Code	270671275
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

ICONIX 2.3 GUIDE

Facility

$1,750.00

Hospital Charge Code	270680690
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

Know your out-of-pocket cost for care.

All Charges